How Do Different Diffuse Large B-Cell Lymphoma Subtypes Impact Treatment Options?

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How Do Different Diffuse Large B-Cell Lymphoma Subtypes Impact Treatment Options? from Patient Empowerment Network on Vimeo.

How are diffuse large B-cell lymphoma (DLBCL) subtypes impacting treatment options? Expert Dr. Nirav Shah from the Medical College of Wisconsin explains key factors that help determine DLBCL subtype and the importance of knowing your subtype for optimal care. 

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…know your subtype of diffuse large B-cell lymphoma, so you can understand what treatment is best for that variant.”

See More from [ACT]IVATED DLBCL

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Transcript:

Lisa Hatfield:

What are the subtypes of DLBCL, and how does that impact treatment options? 

Dr. Nirav N. Shah:

Yeah, so I think I may have talked about that a little bit earlier. So we call it diffuse large B-cell lymphoma, but it’s really not one disease, there are multiple subtypes, so one thing is a cell of origin, and this sort of says what part of the lymph node does this diffuse large B-cell lymphoma originate from. And so there’s something called the germinal center phenotype. The other one is called the activated B-cell phenotype and prognostically, these sort of behave differently. Currently, we’re treating them the same, but we’re hoping that in the future, we’ll actually have algorithms that are more refined so that they are giving the best treatment for each subtype.

I mentioned earlier that there’s a variant called double-hit lymphoma that we think is particularly aggressive, and for that variant, I would actually consider clinical trials as an option if they’re available to you, but outside of a clinical trial, we do give higher intensity chemotherapy regimens, there’s more than one standard of care in that setting. But, again, important to understand what is your DLBCL type and what are some of these other molecular mutations that might be there that would impact that frontline treatment. So my activation tip for this is to know your subtype of diffuse large B-cell lymphoma, so you can understand what treatment is best for that variant. 

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What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma?

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What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma? from Patient Empowerment Network on Vimeo.

What is the diffuse large B-cell lymphoma (DLBCL) system called Ann Arbor staging? Expert Dr. Nirav Shah from the Medical College of Wisconsin explains how DLBCL differs from other blood cancers and symptoms that characterize each DLBCL stage.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…make sure they really understand their scan and what stage they are, and how that impacts the treatment that the doctor is offering.”

See More from [ACT]IVATED DLBCL

Download Resource Guide

Download Resource Guide en español

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How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient

How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient?

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How Can Patients Overcome Noted Diffuse Large B-Cell Lymphoma Disparities

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Transcript:

Lisa Hatfield:

I know as a blood cancer patient, my number one question is, what stage do I have and what is my prognosis? So can you explain the staging system a little bit, I think it’s called the Ann Arbor staging system for DLBCL and then maybe prognoses that you may or may not feel comfortable giving to each patient.

Dr. Nirav N. Shah:

Yeah, so lymphoma is a little bit different, because it’s a blood cancer that involves lymph nodes, and so how we stage it is based on the location and the number of lymph nodes involved, if, for example, you had one lymph node in your neck, and that’s all you had, we would consider you to have stage I diffuse large B-cell lymphoma. If you had more than one lymph node, but on the same half of the body, thinking of your diaphragm as sort of a midpoint, we would then consider you to have stage II disease. If you have lymph nodes on both halves of the body, we would then consider you to have stage III disease, and if you have organ involvement, so bone marrow involvement, liver involvement, kidney involvement or lung involvement, we consider those patients to be stage IV.

Now, to a certain degree, the higher the stage, the worse the prognosis, but as I stated earlier, even patients with stage IV lymphoma can be cured, and that’s different than other cancers, right? When we think about stage IV colon or stage IV breast, many of those patients, we actually tell them that they’re in a non-curative setting, and so while the prognosis for stage III and IV is a little bit worse than those patients who have stage I to II disease, I do try to focus on that we do treat with curative intent, and we do alter our treatment regimens according to the stage of disease that they present with, and so my activation tip for patients in this setting is to make sure they really understand their scan and what stage they are, and how that impacts the treatment that the doctor is offering. 

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How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient?

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How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient? from Patient Empowerment Network on Vimeo.

How do diffuse large B-cell lymphoma (DLBCL) experts explain this cancer to newly diagnosed patients? Expert Dr. Nirav Shah shares his perspective on how he leads patients through their diagnosis and treatment phases and key points that he shares to educate his patients.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…learn as much as they can about this diagnosis and take notes, because I know that often patients in that first visit don’t really register everything. Just because they’re feeling overwhelmed.”

See More from [ACT]IVATED DLBCL

Download Resource Guide

Download Resource Guide en español

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What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma

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Why Is Clinical Trial Participation Vital for Diffuse Large B-Cell Lymphoma Patients

Transcript:

Lisa Hatfield: 

Okay. So, Dr. Shah, you have a patient that comes into your office newly diagnosed with DLBCL, maybe from their…or they’ve heard it from their primary care provider, they understand, they looked it up on the Internet, diffuse large B-cell lymphoma, they see the lymphoma, I would anyway, I’d see lymphoma, and I know it’s cancer. What’s included in your initial evaluation, how do you explain in basic terms to a newly diagnosed patient what DLBCL is? 

Dr. Nirav N. Shah: 

Yeah, great question, Lisa. I think that any time somebody gets that diagnosis with a cancer label on it, it’s incredibly overwhelming, and so what I try to do when I see my new patients is first simply just learn about them. How did this come about, what symptoms led to this diagnosis? Learn about their past medical history, which impacts how I might treat them and what options I’m going to give them, and sort of learn about who they are a little bit, learn about their family, what they do for a living, because I think those are important values to know about your patients, when trying to make a treatment decision.

What I try to explain to these patients is that DLBCL, yes, it is a cancer. Yes, it is, unfortunately, an aggressive cancer, one that can be very rapidly growing, but unlike a lot of cancers, it is a curable type of cancer, and I really try to highlight that like all cancers, unfortunately, not every single patient is cured with diffuse large B-cell lymphoma, but initially, I think there’s reason to have optimism and hope because the goal is, for me, when I meet a new DLBCL patient to provide a curative intent treatment approach for them.

As a part of that initial evaluation, we need to know more about where their disease is and in lymphoma. We often use a PET-CT, which is a special type of scan that sort of lights up areas that can be involved with lymphoma. In some cases, we do a bone marrow biopsy, although that is less indicated now because of how good the PET scans are, and then we talk about other testing, a lot of the chemotherapies can cause problems to your heart, so we often do an ultrasound of your heart to make sure it’s healthy enough to be able to tolerate some of the regimens that we consider for this disease, and then we talk about access in terms of how are we going to get the chemotherapy into the patient, and whether or not they would need a device like a port. But the main focus of the conversation is explaining the disease, teaching about the disease and focusing on that unlike other cancers, even stage III or IV diffuse large B-cell lymphoma is a curable entity, and the key is moving promptly getting the workup done in an efficient but complete manner and then initiating a treatment plan. 

Lisa Hatfield:

Right, thank you. And if you had one tip for patients when they first come in, what would you tell this patient that’s coming to see you in? 

Dr. Nirav N. Shah:

Yeah. I think my activation tip would be to learn as much as they can about this diagnosis and take notes, because I know that often patients in that first visit don’t really register everything. Just because they’re feeling overwhelmed.

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